254.There has been an epidemiological transition of mortality pattern in Bangladesh. Due to the relative decline in deaths caused by infectious diseases, non-infectious causes such as injuries and accidents now are considered to be important factors of child mortality. Study (ICMH and UNICEF, 2003) shows that injuries and accidents contribute to 29 percent of total deaths among children aged 1-4 years.

Table 6.2

Trend in early childhood mortality in Bangladesh, 1993-2004 (per 1,000)

Data source

Approximate reference period

Neonatal mortality

Post-neonatal mortality

Infant mortality

Child mortality

Under-five mortality

BDHS 2004

1999-2003

41

24

65

24

88

BDHS; 1999-2000

1995-1999

42

24

66

30

94

BDHS; 1996-1997

1992-1996

48

34

82

37

116

BDHS; 1993-1994

1989-1993

52

35

87

50

133

255.In order to reduce deaths from diarrhoea, the oral rehydration therapy (ORT) campaign has been in effect for a long time. The ORT campaign is a regular activity in ORT corners in Government hospitals, EPI outreach sites, and home visits by health workers, throughout the country. Oral rehydration solution (ORS) use during diarrhoea increased from 62 percent in 2000 (BBS/UNICEF 2000) to 68 percent in 2003 (BBS/UNICEF, 2003) to 70 percent in 2006 (BBS/UNICEF, 2006).

256.Immunization: Bangladesh contributes to have a record with regard to immunization coverage. The valid coverage of fully immunized children (all doses given at right intervals) increased from 52 percent in 2001 to 63 percent in 2003 and to 71 percent in 2006 (Coverage Evaluation Survey 2000, 2003 and 2006). Both hepatitis B vaccination and Auto Disposable (AD) syringes have been introduced in 2003. Facility Based Integrated Management of Childhood Illnesses (IMCI) activities that began in 2002 cover over 140 of sub-districts (Upazilas) in 2006.

257.There have been various interventions that helped in reduction of mortality rates. Access to vaccination is foremost among them. The BCG coverage was as high as 96 percent in 2003 which went up to 98 percent in 2006. The access to immunization in Bangladesh is very high as seen from the Table below. The rate of measles vaccination was 69 percent in 2003 which went up to 78 percent in 2006. However, it is recognized that the percentage of fully immunized children needs to increase further.

258.National Immunization Day (NID) is being observed for many years very successfully and there was not a single case of confirmed polio in the country between 2001 and 2005. However, several polio cases were detected in 2006 and NIDs have been strengthened. To reduce neonatal deaths due to tetanus, supplementary activities have been carried out. As a result, 86 percent of new-borns are protected at birth against neonatal tetanus. The Government has also introduced from 2003 Hepatitis B vaccination into routine EPI, which has been expanded to all districts from 2005. The following table shows the rate of vaccinations in the country.